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Peer-reviewedCC BYHeart rhythm O2

Circadian patterns of device-detected postoperative atrial fibrillation during 2.5 years of continuous monitoring after cardiac surgery: The RACE V-Tissue Bank Study.

  • Michal J Kawczynski1,2
  • Martijn D Gilbers2,3
  • Joris Winters2,4
  • Bart Maesen1,4
  • Aaron Isaacs2,4,5
  • Dominik Linz4,6,7
  • Michiel Rienstra8
  • Isabelle van Gelder8
  • Jos G Maessen1,4
  • Elham Bidar1,4
  • Ulrich Schotten2,4,6
8 affiliations
  1. 1Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, Maastricht, The Netherlands.
  2. 2Department of Physiology, Maastricht University, Maastricht, The Netherlands.
  3. 3Department of Cardiothoracic surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
  4. 4Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
  5. 5Maastricht Centre for Systems Biology (MaCSBio), Maastricht University, Maastricht, The Netherlands.
  6. 6Department of Cardiology, Heart and Vascular Centre Maastricht University Medical Centre, Maastricht, The Netherlands.
  7. 7Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  8. 8Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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Abstract

Background

Postoperative atrial fibrillation (POAF) is common after cardiac surgery. AF in non-surgical patients exhibits distinct circadian patterns (adrenergic/daytime and vagal/nocturnal), but such patterns for new-onset POAF and recurrent AF remain undefined.Objective

This study aimed to characterize circadian AF patterns and relate chronotypes to clinical, biochemical, histological, and outcome features.Methods

Patients undergoing first cardiac surgery, with and without preoperative AF, were continuously monitored for 2.5 years with an implantable loop recorder. Early AF was defined as AF within 30 days. Patients with sustained AF (≥20 episodes) were chronotyped via circular statistics and local regression of episode duration and ventricular rate (Vrate), and classified as adrenergic, vagal, mixed, or non-rhythmic. Preoperative imaging, electrocardiography, biomarkers, and paired atrial histology were compared across chronotypes.Results

Of the 98 patients (71 without and 27 with preoperative AF), 53 (54.1%) developed POAF (3607 episodes). Patients with prior AF showed a morning onset peak, whereas new-onset POAF showed a uniform 24-hour distribution. Of 26 patients with sustained AF, 20 were rhythmic (9 adrenergic, 7 vagal, 4 mixed), and 6 were non-rhythmic; 27 had incidental AF (<20 episodes). Rhythmic AF correlated with larger atrial volumes, prolonged PR intervals, higher bone morphogenetic protein-10 levels, and greater right-atrial endomysial fibrosis and asymmetry, most pronounced in the mixed chronotype. Adrenergic AF was associated with more arrhythmia-related emergency visits and cardioversions.Conclusion

AF after cardiac surgery comprises distinct circadian subtypes. New-onset POAF and recurrent AF display different circadian patterns, and individual chronotypes are associated with varying degrees of atrial remodeling and clinical outcomes.

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Cite

BibTeXRIS
BibTeX
@article{kawczynski2026circadian,
  title = {{Circadian patterns of device-detected postoperative atrial fibrillation during 2.5 years of continuous monitoring after cardiac surgery: The RACE V-Tissue Bank Study.}},
  author = {Michal J Kawczynski and Martijn D Gilbers and Joris Winters and Bart Maesen and Aaron Isaacs and Dominik Linz and Michiel Rienstra and Isabelle van Gelder and Jos G Maessen and Elham Bidar and Ulrich Schotten},
  journal = {Heart rhythm O2},
  year = {2026},
  month = jul,
  doi = {10.1016/j.hroo.2026.06.023},
  url = {https://europepmc.org/article/MED/42936131},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Circadian patterns of device-detected postoperative atrial fibrillation during 2.5 years of continuous monitoring after cardiac surgery: The RACE V-Tissue Bank Study.
AU  - Michal J Kawczynski
AU  - Martijn D Gilbers
AU  - Joris Winters
AU  - Bart Maesen
AU  - Aaron Isaacs
AU  - Dominik Linz
AU  - Michiel Rienstra
AU  - Isabelle van Gelder
AU  - Jos G Maessen
AU  - Elham Bidar
AU  - Ulrich Schotten
PY  - 2026
DA  - 2026/07/03
JO  - Heart rhythm O2
DO  - 10.1016/j.hroo.2026.06.023
UR  - https://europepmc.org/article/MED/42936131
AB  - Background  Postoperative atrial fibrillation (POAF) is common after cardiac surgery. AF in non-surgical patients exhibits distinct circadian patterns (adrenergic/daytime and vagal/nocturnal), but such patterns for new-onset POAF and recurrent AF remain undefined.Objective  This study aimed to characterize circadian AF patterns and relate chronotypes to clinical, biochemical, histological, and outcome features.Methods  Patients undergoing first cardiac surgery, with and without preoperative AF, were continuously monitored for 2.5 years with an implantable loop recorder. Early AF was defined as AF within 30 days. Patients with sustained AF (≥20 episodes) were chronotyped via circular statistics and local regression of episode duration and ventricular rate (Vrate), and classified as adrenergic, vagal, mixed, or non-rhythmic. Preoperative imaging, electrocardiography, biomarkers, and paired atrial histology were compared across chronotypes.Results  Of the 98 patients (71 without and 27 with preoperative AF), 53 (54.1%) developed POAF (3607 episodes). Patients with prior AF showed a morning onset peak, whereas new-onset POAF showed a uniform 24-hour distribution. Of 26 patients with sustained AF, 20 were rhythmic (9 adrenergic, 7 vagal, 4 mixed), and 6 were non-rhythmic; 27 had incidental AF (<20 episodes). Rhythmic AF correlated with larger atrial volumes, prolonged PR intervals, higher bone morphogenetic protein-10 levels, and greater right-atrial endomysial fibrosis and asymmetry, most pronounced in the mixed chronotype. Adrenergic AF was associated with more arrhythmia-related emergency visits and cardioversions.Conclusion  AF after cardiac surgery comprises distinct circadian subtypes. New-onset POAF and recurrent AF display different circadian patterns, and individual chronotypes are associated with varying degrees of atrial remodeling and clinical outcomes.
SN  - 2666-5018
ER  -